title: Correlation between myocardial fibrosis and restrictive cardiac physiology in patients undergoing retransplantation.
abstract: After cardiac transplant, there is often development of restrictive cardiac physiology. Little is known about the factors that contribute to this physiology and its correlation with pathology. Heart retransplantation provides a valuable opportunity to further understand this relationship. In this study, we investigated the correlation of myocardial fibrosis and restrictive physiology, and possible risk factors utilizing data from all retransplants at our center. A retrospective review of the 30 patients who underwent retransplantation at our institution between 1994 and 2004 was performed. Hemodynamic and imaging data were reviewed for the presence of restrictive physiology. Pathology reports were reviewed for the presence of myocardial fibrosis in the explanted hearts. The cohort with restrictive physiology preceding redo heart transplant had significantly more patients exhibiting myocardial fibrosis compared with the non-restrictive physiology group (94.1% vs. 15.4%, p < 0.001). We found no difference in the immunosuppressive regimen, history of rejection, and reason for transplant. In our study, we observed that myocardial fibrosis is an important contributor to the development of restrictive physiology. Further work needs to be done for risk stratification and the mechanism of fibrosis development.
authors.affiliation: Cedars-Sinai Heart Institute, Heart Transplant Program, Los Angeles, CA, USA.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Itagaki
authors.forename: Rabia R
authors.initials: RR
authors.lastname: Razi
authors.forename: Jignesh K
authors.initials: JK
authors.lastname: Patel
authors.forename: Wanxing
authors.initials: W
authors.lastname: Chai
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kawano
authors.forename: Zachary
authors.initials: Z
authors.lastname: Goldstein
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kittleson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fishbein
mesh_terms: D000328:Adult; D002313:Cardiomyopathy, Restrictive / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000503:physiopathology; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: cardiac allograft vasculopathy; inflammation; myocardial fibrosis; restrictive cardiac physiology; retransplantation